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Medicare and ?????



  • Hi Dave,
    Sounds like things are looking up for you :) Independence is a wonderful thing, enjoy it!

    I am reading and trying to understand all I will need to know in the future. I am very new to SSDI and won't be eligible for Medicare till next summer.
    I have been very spoiled with regards to health insurance. My hubby has great insurance. I have had very little out of pocket expenses. I am so very scared of what is to come...
    I hope I will be as fortunate as you when my time comes :)

    take care,
  • MetalneckMetalneck The Island of Misfit toysPosts: 1,778
    edited 07/10/2012 - 10:04 AM
    Seemed to work well for my rx today .... Co-pay price $9.00 ..... my insurance saved me $314.98 ...... for a $38.00 premium Im already ahead on the deal!! TIme will tell the total tale .... I think I'm gonna do an Excel spead sheet and see how it really comes out at the end of the year.

    Do-nut holes I thought were something we ate ..... not caused our insurance coverage to lapse in the middle of the year then kick back in!! Kinda like a mid term deductible ..... maybe we can not pay our politicians for their mid year term??

    Talk about a "carve out"! Carve outs should be reserved for Turkeys not RX coverage!!!

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  • Hi Dave and the others that posted in this thread
    I have about 7 months before I get the Medicare coverage but in CA it looks tuff to find a good medigap without joining a HMO or ppo that limits who you can see as far as doctors.
    I am so looking forward to the Medicare because my out of pocket counting my insurance premiums has been $18000.00 to what will be almost $22000.00 this year five years of this has wiped me out.
    My biggest question now is can you see what doctors you want and is everything covered under your new plans.
    I found all states have to offer medigap policys for 65 and over but not those of us that are under 65. I did come across one for about 350 a month which will still be better for me then what I have but still another cost to deal with...
    Oh and by the way I understand part of Obama care will phase out that dang donut hole over time so that will be a help at a later date depending on the election of coarse which may or may not change anything anyway.
    I have at least one doctor appointment every two weeks for pain management then add in the other 7 docs I see and copays alone are killing me plus 12 scripts a month too so I hope it gets better for me
    The SHIP program someone wrote about sounds like a good place to start also soory I am on a small tablet and can't scroll up to give the poster credit but thanks for that information.

    Take Care
  • I'm 65 and opted not to take the part of Medicare that pays for a dr. visit. Why? It would have cost me,$100/mo - 10% of my monthly income, still demand co-pays, and then still wouldn't cover everything. That would mean buying still more insurance. Considering that my rent and electric cost nearly 50% of my income, I simply couldn't afford it. Alternately, I could try for some kind of government program that would "help" me, but, I prefer not to sell my soul to the government. I think I'll just continue to live until I die. The only thing that concerns me now is having an injury that I know I can't pay for. But, even with insurance, I couldn't pay for it anyhow. My extras in life are the Internet and a 1998 Honda Civic and I don't want to give them up.
  • MetalneckMetalneck The Island of Misfit toysPosts: 1,778
    Saultup is the member that said he/she is a SHIP Advisor. You could P.M. your question and I'm sure he/she would help or at least steer you in the correct direction.


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  • saultupssaultup Posts: 71
    edited 09/29/2012 - 4:02 PM
    Just saw the last post. As a SHIP counselor, I would suggest that "island fever" check with Social Security to see about eligiblity for Extra Help/Low Income Subsidy and with the state agency that oversees Medicaid. In Michigan the Department of Human Services handles Medicaid applications and in addition to Medicaid, they screen individuals for a program called the Medicare Savings Program. It is a program that pays the monthly Part B fee. Another way of putting this is Medicaid is for low, low income and assets. If one is not eligible for Medicaid, the next level up is possible eligibility for the Medicare Savings Program. Usually if one is eligible for the Medicare Savings Program, one is eligible for the other program administered by Social Security. The Social Security program really helps pay for medications and the costs of a prescription drug plan.
    While not having Part B sounds like not a big deal, remember that outpaitent services are covered under Part B. A lot of surgeries these days are being done on an outpatient basis so it is possible to get a substanial bill for outpatient treatment. Yes, Medigap polices mean buying other insurance to cover the annual deductibles, co-pays etc. that Medicare doesn't cover. For Part B, Medicare pays approximately 80% so the paitent is left with the 20%. Some Medigap policies will cover all of these other expenses.
    I realize a very limited income makes choices even more difficult. The Medicare Savings Program and the Extra Help/Low Income Subsidy are great programs and I would encourage you to check them out. I would encourage you to find a SHIP counselor in your area (go to medicare.gov)and at least discuss what options are available to you in your state. Our services are free. We are not selling anything but just giving out information and helping with advocacy. I'm really interested in people getting the help they are entitled to.
  • Rick,
    You are right in that it might be tougher finding a medigap policy for someone under 65. One bit of encouragement: when you do turn 65, the cost of a medigap policy should be significantly reduced...I mean really reduced. Again, this varies a bit from state to state but generally speaking, these under 65 policies are more expensive (except in MI where we do have access to a policy for under 65 at a reasonable rate of $122.) Good luck in finding one you can afford. They really help. And don't forget to get in a Part D program.
  • Thanks for the input. I just started looking and so far found one for about 349 per month which would be better then what I have to pay now anyway. For the last six years my medical expense counting insurance copays and out of pocket has been from $18000.00 to what will be about $21000.00 this year. I am about out of money, my retirement is almost gone.
    In about 8 months I get Medicare and I hope that helps plus I hope my medical issues slow down too.

    In some of the post above island fever is talking about waving off part B isn't he going to pay a penalty each year he doesn't buy B. I was told each year you don't buy it you pay a 10% penalty if you add it later so 10 years without B you would pay 200% of the cost. Is this right?

  • You're right, Rick.
    If you don't sign up for Part B and you don't have other insurance, there is a penalty which is 10% for every year (that is a full 12 months) that you went before signing up. The good news is if you are on Medicare and are under 65 and you didn't sign up for Part B, the penalty disappears when you turn 65 and are in a new enrollment period. Otherwise, it just keeps on building up.
    There is also a penalty for Part D. That penalty is 1% for every month that you could of signed up but didn't and you did not have "creditable" drug coverage through another source.
  • Yep, I didn't sign up for a pharmacy plan within the first 6 months, mostly because my meds are paid by workers compensation because my injury was work related. I didn't see the need because I don't take any other meds. About a year into Medicare, I decided to get the part D. Makes me mad that I now pay a penalty on my prescription drug plan. By the time I pay the $100 for Medicare, $40 for prescription coverage, and now $378 for my plan F coverage (which is great), that is a big chunk of my income. But there is no way I can get rid of the coverage.

    I was speaking with my doctor just today about Medicare. He predicts that in the very near future, most doctors will quit accepting medicare patients. He said they already limit the number they will take, because the amount Medicare pays is so ridiculously low. It used to be that it was only Medicaid that had the poverty stigma, but now Medicare is getting a very similar stigma and doctors don't want to participate. That scares me.
    Surviving chronic pain one day at a time, praying for a reprieve because living another 40 years like this doesn't sound too fun!
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